Category: Brain Injury; International; Health Services Research
Objective : To explore the relationship between the social determinants of health (SDH) and psychological distress in adults with a self-reported traumatic brain injury (TBI).
Design :
Cross-sectional study.
Setting :
Ontario, Canada.
Participants (or Animals, Specimens, Cadavers) :
Adults age 18 years or older with a self-reported traumatic brain injury identified through the Centre for Addiction and Mental Health (CAMH) Monitor Survey 2014-2017.
Interventions :
Not applicable.
Main Outcome Measure(s) :
Psychological distress, measured using the Kessler Psychological Distress Scale (K6).
Results : Between 2014 and 2017, 1,185 adults reported experiencing a TBI, 36.4% of whom were women. The prevalence of psychological distress was 30.2% among men and 40.1% among women. Logistic regression analyses revealed that the following SDH were significantly associated with psychological distress: (a) gender – men vs. women (OR=0.618; CI=0.426-0.898); (b) income and social status – household income <$70,000 vs. $70,000+ (OR=1.630; CI=1.042-2.550); (c) education and literacy – post-graduate/professional degree vs. college/bachelor's degree (OR=0.486; CI=0.247-0.954); (d) biology and genetic endowment – age 18-29 years (OR=1.341; CI=7.493), 30-39 years (OR=1.901; CI=1.045-3.458), 65+ years (OR=0.384; CI=0.231-0.672) vs. 50-64 years); and (e) social supports and coping skills – marital status divorced/separated vs. married/living with partner (OR=1.883; CI=1.159-3.060).
Conclusions : Targeted programs and interventions for specific groups of TBI survivors are encouraged, including an increased awareness of the susceptibility to psychological distress among TBI survivors of lower income brackets, who are divorced/separated, and aged 18-39 years. In-depth research to explore the unique psychological challenges and needs of diverse populations of TBI are recommended.
Lauren Marcus
– MScOT Trainee, University of Toronto, Toronto, OntarioDanielle Burlie
– MScOT Trainee, University of Toronto, Toronto, Ontario
Angela Colantonio
– Professor and Director, University of Toronto, Toronto, OntarioRobert Mann
– Senior Scientist, Centre for Addiction and Mental Health, Toronto, OntarioVincy Chan
– Scientific Associate III, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario